The Mexican consensus on non-cardiac chest pain

Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by ret-rosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced byesophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding the definition, epidemiology,pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options forthose patients. Methods Three general coordinators carried out a literature review of all articles published inEnglish and Spanish on the theme and formulated 38 initial statements, dividing them into 3 maincategories: 1) definitions, epidemiology, and pathophysiology, 2) diagnosis, and 3) treatment.The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statementswere those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions The final consensus included 29 statements. All patients presentingwith chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initialapproach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagiaor alarm symptoms are present, endoscopy is recommended. High-resolution manometry isthe best method for ruling out spastic motor disorders and achalasia and pH monitoring aidsin demonstrating abnormal esophageal acid exposure. Treatment should be directed at thepathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/orsmooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionallysurgery or endoscopic therapy

Consenso mexicano sobre dolor torácico no cardiaco

Introducción: Dolor torácico no cardíaco (DTNC) se define como un síndrome clínico caracte-rizado por dolor retroesternal semejante a la angina de pecho, pero de origen no cardiaco ygenerado por enfermedades esofágicas, osteomusculares, pulmonares o psiquiátricas.Objetivo: Presentar una revisión consensuada basada en evidencias sobre definición, epidemio-logía, fisiopatología, diagnóstico y opciones terapéuticas para pacientes con DTNC.Métodos: Tres coordinadores generales realizaron una revisión bibliográfica de todas las publi-caciones en inglés y espa˜nol sobre el tema y elaboraron 38 enunciados iniciales divididosen tres categorías principales: 1) definiciones, epidemiología y fisiopatología; 2) diagnóstico,y 3) tratamiento. Los enunciados fueron votados (3 rondas) utilizando el sistema Delphi, y losque alcanzaron un acuerdo > 75% fueron considerados y calificados de acuerdo con el sistemaGRADE. Resultados y conclusiones: El consenso final incluyó 29 enunciados Todo paciente que debutacon dolor torácico debe ser inicialmente evaluado por un cardiólogo. La causa más común deDTNC es la enfermedad por reflujo gastroesofágico (ERGE). Como abordaje inicial, si no existensíntomas de alarma, se puede dar una prueba terapéutica con inhibidor de bomba de pro-tones (IBP) por 2-4 semanas. Si hay disfagia o síntomas de alarma, se recomienda hacer unaendoscopia. La manometría de alta resolución es el mejor método para descartar trastornosmotores espásticos y acalasia. La pHmetría ayuda a demostrar exposición esofágica anormal alácido. El tratamiento debe ser dirigido al mecanismo fisiopatológico, y puede incluir IBP, neu-romoduladores y/o relajantes de músculo liso, intervención psicológica y/o terapia cognitiva,y ocasionalmente cirugía o terapia endoscópica. ABSTRACT Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by retros-ternal pain similar to that of angina pectoris, but of non-cardiac origin and produced byesophageal, musculoskeletal, pulmonary, or psychiatric diseases.Aim: To present a consensus review based on evidence regarding the definition, epidemiology,pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options forthose patients. Methods: Three general coordinators carried out a literature review of all articles published inEnglish and Spanish on the theme and formulated 38 initial statements, dividing them into 3 maincategories: (i) definitions, epidemiology, and pathophysiology; (ii) diagnosis, and (iii) treatment.The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statementswere those that reached > 75% agreement, and they were rated utilizing the GRADE system.Results and conclusions: The final consensus included 29 statements. All patients presentingwith chest pain should initially be evaluated by a cardiologist. The most common cause ofnon-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. Ifdysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution mano-metry is the best method for ruling out spastic motor disorders and achalasia and pH monitoringaids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at thepathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/orsmooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionallysurgery or endoscopic therapy

¿Cuánto sabe el especialista sobre cardiogastroenterología?

Resumen: Introducción y objetivos: La enfermedad cardiovascular (ECV) es un problema creciente de salud pública. El 40% de la población general en 2030 presentará ECV y como consecuencia requerirá terapia antitrombótica (TAA). La cardiogastroenterología (CGE) es una nueva área de conocimiento que evalúa los efectos y complicaciones gastrointestinales de la TAA. Nuestro objetivo fue evaluar mediante una encuesta validada el conocimiento en prescripción, farmacología, riesgos y complicaciones gastrointestinales de la TAA en un grupo de especialistas y residentes de gastroenterología (RG) y medicina interna (RMI). Pacientes y métodos: Se aplicó una encuesta validada de 30 preguntas en un grupo de especialistas y RMI y RG. La encuesta incluyó preguntas de indicaciones, farmacología, evaluación de riesgo de hemorragia gastrointestinal, riesgo trombótico y el uso de TAA durante procedimientos endoscópicos. Se definió conocimiento suficiente como ≥ 18 (> 60%) aciertos. Resultados: La encuesta fue contestada por 194 médicos: 82 (42%) RMI y RG y 112 (58%) especialistas. Solo 40 (20.6%) tuvieron conocimiento suficiente en CGE. Los residentes tuvieron un mayor número de aciertos que los especialistas (53% vs. 36%, p < 0.0001). Los RG tuvieron más aciertos que los RMI, RG e internistas (70% vs. 53%, 40% y 46%, respectivamente, p < 0.001). Solo los residentes tuvieron conocimiento suficiente en farmacología y uso de la TAA en endoscopia (p < 0.0001). Todos los grupos tuvieron conocimiento insuficiente en evaluación de riesgo trombótico-hemorrágico. Conclusiones: Existe conocimiento insuficiente sobre CGE en este grupo de residentes y especialistas. Se requieren programas de educación médica acerca del uso apropiado de la TAA. Abstract: Introduction and aims: Cardiovascular disease is a growing public health problem. Forty percent of the general population will suffer from the disease by 2030, consequently requiring antithrombotic therapy. Cardiogastroenterology is a new area of knowledge that evaluates the gastrointestinal effects and complications of antithrombotic therapy. Our aim was to evaluate, through a validated questionnaire, the knowledge held by a group of specialists and residents in the areas of gastroenterology and internal medicine, about pharmacology and drug prescription, as well as gastrointestinal risks and complications, in relation to antithrombotic therapy. Patients and methods: A validated questionnaire composed of 30 items was applied to a group of specialists and residents in the areas of gastroenterology and internal medicine. The questions were on indications, pharmacology, evaluation of risks for gastrointestinal bleeding and thromboembolic events, and use of antithrombotic therapy during endoscopic procedures. Sufficient knowledge was defined as 18 or more (≥ 60%) correct answers. Results: The questionnaire was answered by 194 physicians: 82 (42%) internal medicine residents and gastroenterology residents and 112 (58%) specialists. Only 40 (20.6%) of the participants had sufficient knowledge of cardiogastroenterology. Residents had a higher number of correct answers than specialists (53 vs. 36%, P<.0001). The gastroenterology residents had more correct answers than the internal medicine residents, gastroenterologists, and internists (70 vs. 53, 40, and 46%, respectively, P<.001). Only residents had sufficient knowledge regarding pharmacology and the use of antithrombotic therapy in endoscopy (P<.0001). All groups had insufficient knowledge in evaluating the risk for gastrointestinal bleeding and thrombosis. Conclusions: Knowledge of cardiogastroenterology was insufficient in the group of residents and specialists surveyed. There is a need for medical education programs on the appropriate use of antithrombotic therapy. Palabras clave: Cardiogastroenterología, Hemorragia de tubo digestivo, Terapia antitrombótica, Educación médica, Keywords: Cardiogastroenterology, Gastrointestinal bleeding, Antithrombotic therapy, Medical educatio

Pharmacological cardioversion after pre-treatment with antiarrythmic drugs prior to electrical cardioversion in persistent atrial fibrillation : Impact on maintenance of sinus rhythm

Background: Antiarrhythmic drugs (AADs) are frequently initiated in patients with persistent atrial fibrillation (AF) prior to electrical cardioversion (ECV), achieving pharmacological cardioversion (PCV) in some cases. Little is known about the mode of cardioversion and the effect of the type of AAD used in the maintenance of sinus rhythm (SR). Methods: From three national surveys of patients with persistent AF referred for ECV, we selected those who were pre-treated with AADs (amiodarone or group Ic AADs). We analyzed the effect of the type of cardioversion (pharmacological vs. electrical) and the AAD used in the maintenance of SR at three months. Results: Among the 665 patients selected, 151 had a successful PCV prior to the planned ECV. In the remaining 514 patients, 460 had a successful ECV. A successful PCV was related to a higher rate of SR maintenance than a successful ECV (77.9% vs. 57.5%; p < 0.0001). After a successful PCV, the maintenance of SR was identical in those patients treated with amiodarone and those treated with group Ic AADs (77.4% vs. 77.5%; p = 0.99), whereas after a successful ECV, amiodarone was clearly superior to group Ic AADs (61.3% vs. 43.0%; p = 0.001). Considering patients with successful PCV and ECV together, PCV was an independent factor related to the maintenance of SR. Conclusions: In patients with persistent AF, successful PCV selects a subgroup with a high probability of maintenance of SR. With regard to drugs, amiodarone was superior to group Ic AADs in patients with ECV, whereas in PCV, no differences were observed

Extensive nonhomologous meiotic synapsis between normal chromosome axes of an rcp(3;6)(p14;q21) translocation in a hairless Mexican boar

Due to its low fertility, expressed as small litter size, a Mexican hairless boar was subjected to cytogenetic investigation. Analysis of G-banded mitotic chromosomes revealed a reciprocal chromosome translocation, rcp(3;6) (p14;q21). Synaptonemal complex analysis showed a regular pairing behavior of the translocation chromosome axes, always resulting in a quadrivalent configuration. However, due to extensive nonhomologous pairing between the axes of nonderivative chromosomes 3 and 6, the quadrivalent mostly had an asymmetrical cross-shaped morphology. The nonhomologous pairing occurred not only at mid and late pachytene, but also at the earliest stage of pachytene. It seems that early pachytene heterosynapsis is a common phenomenon in the pairing behavior of pig reciprocal translocations. Therefore, heterosynapsis may reduce apoptosis of germ cells due to partial absence of homologous synapsis during the pairing phase of meiosis. The frequency of spermatocytes showing quadrivalent configurations with unpaired axial segments apparently did not affect germ cell progression in the boar, since fairly normal testicular histology was noticed. Copyright � 2008 S. Karger AG